Provider Demographics
NPI:1316546484
Name:CIAMPA, WALTER J JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:J
Last Name:CIAMPA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FRIENDSHIP LN
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1023
Mailing Address - Country:US
Mailing Address - Phone:978-406-1192
Mailing Address - Fax:
Practice Address - Street 1:2 FRIENDSHIP LN
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-1023
Practice Address - Country:US
Practice Address - Phone:978-406-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23003183500000X
FLPS30913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist